Do I Know Enough?

(Short answer: No. But maybe that’s a good thing.)

This is a question every doctor asks themselves at some point — usually many times over. The feeling that you don’t know enough creeps in at the start of FY1, medical school it you weren't a total f**kabout like I was, and never entirely leaves. In fact, it might be one of the more helpful nagging things to keep around, like a Spouse or a really vocal Potplant, it's something that keeps you grounded in simple routine. Only carnally engage with one of these things though.

Short answer though? No. You don’t know enough. None of us do.

Medicine is too vast, too complicated, too fluid to ever truly “know enough.” The moment you think you do, the Dunning-Kruger effect taps you on the shoulder. Early-stage medical students routinely overestimate their academic performance — showing that confidence often peaks when competence is lowest. This inverse relationship can persist if not corrected by reflection and feedback.

I went to a Private school (yes, I know - please continue to boo because it gets me all giddy with sexual thrill), mostly because my Grandad could afford to send us to make sure that if I was getting beaten up - it wasn't by someone who couldn't afford to make the problem go away afterwards. It was very crass to be honest, and I'm not trying to claw back credibility; what that sort of money gets you is coaching. We learned to pass exams, not learn - anything, really. I left private school with some grades and the knowledge on how much Glen's Vodka you can drink in a park before passing out. You know, life skills.

When I say my first exams in medical school in a haze of hazing and a drink called Purple Haze (that you drank, inhaled and snorted - so yeah, safe) I was reasonably confident in my intelligence. I tanked them all. It was a massacre. I learned that day that I knew nothing about learning independantly at all.

To quote the famous Monty Python "I got better"

That said, the deeper you go, the greyer it all becomes. Even during technical training (e.g. central line placement), residents often underestimate their own capability — especially women — reflecting not a lack of knowledge, but a pervasive lack of confidence tied to systemic factors.

Some specialties are more comfortable embracing uncertainty. General Practice and A&E live in the grey zone.

"Oh, you think greyness is your ally. But you merely adopted the grey; I was born in it, moulded by it"

Consultants eventually develop pattern recognition, but they do so by navigating ambiguity, failing, recalibrating — again and again. That’s how "knowing" happens, by repetition, remembering and a reductive rhetoric to fuck-around-and-find-out.

As a junior, the temptation is to mask your gaps with bravado - I know for a fact I did this. One of my favourite ever bits of ePortfolio feedback I ever got was as follows:

"Dr Wandless gives off an air of being overconfident and arrogant. Frustratingly, I've not seen him make a mistake - so one would propose to watch this to assess if merely insecure bravado or naked narcassistic confidence"

Genuine quote. I will show you the paperwork at request. To repeat - I am that dickhead but the meds keep me stable.

Part of the overall issue is that self-assessment in medicine is notoriously flawed — and the most dangerous clinicians are often the ones least aware of their own limitations. Real strength lies in transparency. The best trainees aren’t encyclopaedias — they’re curious, coachable, and open.

For example, when things in FY1 got really ripe and I was firmly in the "Valley of Despair" on the right side of Mount stupid (god I love the Dunning-Kruger Effect) I spoke with a Registar I had, to this point (and still) trusted to be honest but fair. He had a very Ernest Hemingway, rebel-without-a-cause sort of energy — all direct eye contact, rolled-up sleeves, and a brutal kind of kindness. The kind of doctor who didn’t sugarcoat anything but also never let you drown. I told him I felt like I didn’t know what I was doing, like I was faking it every shift. He didn’t blink. He just said, “Good. That means you’re probably safe. It’s the ones who think they’ve got it all figured out you need to worry about.” Then he handed me a biscuit and went back to typing discharge letters like it was the most normal thing in the world.

Then the worst doctor I've ever worked with walzed in and said "I'm finally getting the hang of this I think". And so the climb of Mount Stupid claimed another life that day...

So how do you get better?

Just remember - good consultants don’t expect perfection. But they do expect honesty in what you know and don't know. They’re more likely to fill an empty cup than one spilling with misplaced confidence.

Learn how you learn. It doesn’t matter whether it’s spaced repetition, problem-based, flashcards, or case-based. Know your gaps. Own them. Address them in real clinical settings — because memory anchored to patient stories sticks deeper than abstract facts. And when repetition shows a consistent blind spot? Don’t ignore it. Revisit it until it stops being a gap.

Soft skills are harder still. Knowing how to have tough conversations. How to read a room. When to pause. These aren’t things you’ll find on Geeky Medics or Osmosis videos — but they’re often the things that make you feel genuinely competent.

“Knowing enough” isn’t a finish line. It’s not about reaching total mastery. It’s about calibration. Knowing enough to keep a patient safe. To explain clearly. To ask for help at the right moment.

So if you don’t feel like you know enough? Good. That means you probably care enough to ask. That’s the kind of doctor your patients need.

And if in doubt - there’s always Wikipedia.

Stay Positive

DW